Close the infection loop to reduce outbreak risk
Much of the attention paid to the “Protecting Access to Medicare Act of 2014” legislation signed into law by President Obama earlier this month focused on preventing a 24 percent cut in Medicare reimbursements to doctors for one year. The legislation includes several other health policy changes, including a one-year delay of implementing a complicated coding system for doctors and hospitals, and a provision that is of particular interest to skilled nursing facility administrators: a new value-based purchasing (VBP) program based on hospital readmissions.
The readmission scores of nursing homes will be posted to the Nursing Home Compare website beginning in 2017, and the VBP program will begin Oct. 1, 2018. For the first time, facilities will not just face financial penalties, they will be incentivized to reduce readmissions. However, the issue here is not whether nursing homes need this incentive. After all, re-admissions reduce census and referrals, which directly impacts P&L. The real issue is how to reduce re-admission rates. One key step is preventing an infectious disease outbreak by addressing the three primary transmission vectors: airborne, surface contact and person-to-person contact, before an outbreak occurs. Closing this infection loop reduces re-hospitalizations and maintains census, a top financial and clinical priority for all long-term care facilities.
Not all airborne pathogens are the result of someone sneezing or coughing. The term “aerial dissemination” describes particles entering the air for a short time – even for only a few minutes – that can also fall onto exposed surfaces. Particles may become disturbed via common activities such as floor polishing or bed making. When these particles land, they can either infect patients directly or indirectly through the contamination of clinically important surfaces. The point remains, that while protocols on hand washing and surface cleaning are vital first steps to reduce infection, this has been the singular approach for a long time and it still hasn't fully resolved the growing infection challenges that healthcare faces.
A recent report by the Department of Health and Human Services Office of Inspector General provides evidence that skilled nursing facilities are struggling to close the infection loop. The OIG found nearly a quarter of Medicare patients discharged to nursing centers for rehabilitation experienced “adverse events” resulting in harm from medical care. Infections represent 1 of 3 main categories of adverse events, and an examination of the data reveals that facilities are not adequately addressing the threat posed by airborne pathogens.
The OIG report adds additional detail with a breakdown of the events related to infections. “Aspiration pneumonia and other respiratory infections” typically caused by airborne pathogens account for 10 percent, more than double surgical site infections (SSI) associated with wound care, infections caused by urinary tract infection associated with catheter (CAUTI), and Clostridium difficile infection. This shows that while infection control programs commonly address the latter two, they are not as effective against airborne pathogens.
When it comes to preventing aerial dissemination, technology can enhance what antibiotics alone have been asked to do for decades. This is an urgent need for many reasons. The World Health Organization (WHO) recently published a report on growing antibiotic resistance. This was the most comprehensive perspective on the issue and included data from over 114 countries. The conclusions of the report include the need to enhance infection prevention and control.
Our company, Novaerus, is an innovator of airborne pathogen control technology that scrubs the air using a unique plasma field. While not a cure-all, it should be part of a comprehensive infection prevention program, implemented in conjunction with traditional policies and best practices, such as enforcing protocols on hand washing, instrument and surface sterilization, and training staff on how to prevent the spread of pathogens.
Nursing home administrators and directors of nursing do not need Congressional action to realize infections have a significant impact on the economic, clinical, environmental and marketing aspects of their facilities. Prevention, not reacting to an outbreak after it has occurred with increasingly ineffective antibiotics, is the key to completing the infection control and prevention loop and reducing re-admission rates.
Bill McCabe is the CEO of Novaerus.